How Research is Changing the Conversation about Obesity
This story was published in the February 2024 issue of the Breakthroughs newsletter.
This is part of a two-part series covering anti-obesity medications and the research Feinberg faculty are leading. This first part will cover the anti-obesity medications being used to treat obesity and advocacy that is happening to improve access for patients.
In the last several years, anti-obesity medications have made an impression through wide media coverage and interest in their effectiveness. Celebrities and influencers on social media have touted their weight loss results. But the impact of these drugs is still yet to be realized as there are issues with access including insurance coverage, high costs, supply chain challenges, stigma and more. Feinberg investigators have been leading research on these drugs for the treatment of obesity and advocating for access to these medications for the patients who need it most.
According to the Centers for Disease Control and Prevention, nearly 42 percent of people living in the U.S. are living with obesity. Robert Kushner, MD, has been leading clinical trials of anti-obesity medications and has received recognition for his work, including the prestigious Herbert Pardes Clinical Research Excellence Award from the Clinical Research Forum. Kushner, professor of Medicine and Medical Education, and his collaborators found that semaglutide (sold under the names Ozempic and Wegovy) was almost twice as effective at helping individuals lose weight than many of the current weight-loss drugs on the market, according to findings published in the New England Journal of Medicine.
The landmark trial, published in 2021, showed that semaglutide, a GLP-1 reception agonist, injected subcutaneously once a week at 2.4 mg, works by suppressing appetite centers in the brain to reduce hunger and calorie intake.
Since the landmark trial, another study published in Nature Medicine looked at tirzepatide, which is a “dual agonist,” in that it combines glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonism to suppress appetite and reward-seeking behaviors from food in the brain. In November, the FDA approved tirzepatide for obesity.
These two drugs are just the beginning. According to Kushner, this new class of drugs could make a large impact on addressing the obesity epidemic.
“We are really trying to shift the conversation so that it’s not about weight loss, but it’s about improved health and weight loss is just a parameter of improved health,” Kushner said.
Addressing Challenges with Access
Justin Ryder, PhD, associate professor of Surgery in the Divisions of Pediatric General Surgery and of Pediatrics and vice chair for research in the Department of Surgery at Ann H. and Robert Lurie Children’s Hospital, has been involved in advocating for Illinois Medicaid to cover these anti-obesity medications for children and adults.
“With kids, the thought has been to put effort into preventing obesity, but that hasn’t been effective as the numbers have risen over the years. We can see that this is because we have been trying to treat behaviors rather than biology.”
Ryder describes obesity as a multifactorial disease impacted by a robust gene-environment interaction.
“We need to see obesity as a disease. It’s not a behavior,” he said.
Obesity is expensive to treat and can have many comorbidities or associated conditions. These drugs can cost more than $1,000 a month without insurance coverage.
Ryder worked with Illinois Medicaid and the Department of Healthcare and Family Services to change administrative code to provide coverage for antiobesity medications. Three anti-obesity medications — Wegovy for teens and adults, Saxenda for teens and adults, and Zepbound for adults — will be added to Medicaid coverage in early 2024. He expects that more approvals for anti-obesity medications will be coming this year with a full class review pending.
Despite access through Medicaid expanding, there are still challenges physicians and patients face with access, including supply chain issues, health insurance coverage, or even stigma.
“Not to be hyperbolic, but this really is groundbreaking,” Kushner said. “Treating obesity is really difficult and studying these drugs and being able to provide them has been a really rewarding part of my career. It’s about quality of life, it’s about hearing my patient’s stories and doing what they always wanted to do. It’s lifechanging for people.”
Pursuing Further Research
Longitudinal data is necessary to better understand the long-term impacts of being on these medications. Kushner said the drugs have been tested for as long as four years in people, but future research will need to explore if these drugs need to be taken for life like diabetes medication or statin therapy.
“There are questions about the intensity, frequency and components of lifestyle behavioral treatment that need to be paired with medications. It’s still an area that needs more research,” Kushner said.
Ryder also wrote a commentary in JAMA Network Open refuting an analysis that compared the cost-effectiveness of treatments for obesity in children including anti-obesity medications. In the analysis, he argues that it isn’t fair to compare bariatric surgery to anti-obesity medication because it’s still early in the process.
“I felt like this was premature because we don’t yet have long term data on these drugs,” Ryder wrote.
Ryder said it is necessary to have five to 10 years of data to do these cost-effective analyses.
“This is an inflection point and I think we will start to see obesity rates decrease over the next five years,” Ryder said. “It’ll take longer to see that for kids, but it’s worth the fight. I’m optimistic.”
Next month, as part two of this series, we will cover anti-obesity medications that are being tested in clinical trials to treat heart disease and how scientists and physicians are addressing health equity challenges around these drugs.